Helping schools and healthcare facilities in Madagascar, Nepal and Tanzania promote better hand hygiene practices through behaviour change campaigns.

Where are we working?

We are implementing hygiene promotion programmes across 74 schools and 45 healthcare facilities in Madagascar, Nepal and Tanzania.

In Madagascar, we're working in schools and health centres in the central Analamanga region. In 2021, only 37% of schools in Madagascar had access to a basic water service, and one in three health centres had hand hygiene facilities at points of care. 

In Nepal, we're working in Siraha District in Madhesh Province, located in the Terai belt. In 2022, more than nine in ten people in Nepal had access to a basic water service and nearly two-thirds had basic hygiene. But less than half of schools have a basic water service, according to 2021 data

We are also working in schools and health centres in the Kisarawe District of Tanzania. In 2021, only 15% of schools and 42% of healthcare facilities in Tanzania had basic hygiene services. Many health centres also fail to comply with national guidelines for water, sanitation and hygiene (WASH) because of insufficient facilities.

Female nurses washes her hands at a tap.
Sunita Kharel, senior auxiliary nurse midwife, washing her hands, Nepal. September 2020.
Image: WaterAid/Mani Karmacharya

What are we doing?

Research suggests that hygiene interventions that use emotional triggers are more effective at changing behaviors. Through this project – formally titled "Data collection survey on improving hygiene behaviour in schools and healthcare facilities with international NGOs" –  we are conducting surveys and pilot activities in schools and healthcare facilities to understand how people practice hygiene. We are then using the results to determine the best ways to improve hand hygiene in these settings.

The project aims to:

  • Enhance hand hygiene behaviours in schools and healthcare facilities, and ensure these behaviours are sustained
  • Develop a rigorous evidence base on hand hygiene in the target settings to inform wider practice

To achieve this, we are:

  • Conducting preliminary surveys about effective hygiene improvement strategies
  • Creating and implementing hygiene behaviour change campaigns, including interactive games and nudges designed to encourage positive behaviours
  • Building and improving WASH facilities, including water supply systems, gender-separated and disability-inclusive toilets, and handwashing facilities
  • Improving the capacity of local stakeholders to manage and maintain WASH facilities
  • Investigating the impact of behaviour change campaigns on students, their families and healthcare staff, using randomised controlled trials and cross-sectional studies
  • Developing hygiene improvement handbooks for schools and health centres

Who are we working with?

Teams from WaterAid Madagascar, Nepal, Tanzania and the UK are providing technical support to development partners and government bodies at national, regional, district and local levels, including:

  • Ministries of education and ministries of health, to ensure scale and sustainability of the project
  • Local academic institutions and consultants, to conduct research and studies
  • Creative partners and institutions, to implement hygiene behaviour change campaigns
  • School and healthcare facility management committees, to inform intervention design and implement project activities

This page will be updated as the project progresses.

Top image: Tefy, 10, with his best friends, Satriniaina and Salohy, 10, washing their faces and drinking water at the handwashing station of their school sanitation block, Manjakandriana commune, Madagascar, January 2023.